Provider Demographics
NPI:1174614028
Name:EARS, NOSE & THROAT CONSULTANTS OF VIRGINIA, P.C.
Entity type:Organization
Organization Name:EARS, NOSE & THROAT CONSULTANTS OF VIRGINIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:434-817-2300
Mailing Address - Street 1:1000 E HIGH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4848
Mailing Address - Country:US
Mailing Address - Phone:434-817-2300
Mailing Address - Fax:434-817-2306
Practice Address - Street 1:1000 E HIGH ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4848
Practice Address - Country:US
Practice Address - Phone:434-817-2300
Practice Address - Fax:434-817-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACB0157Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VAC00391Medicare ID - Type UnspecifiedGRP MEDICARE NUMBER